Prenatal visits provide access to and continuity of care for pregnant women and thus represent an excellent opportunity for clinicians to assess for and intervene in IPV. Patients should be routinely screened for new or ongoing abuse during each prenatal visit. Women
are more often physically abused in the year before pregnancy and even if the abuse stops or decreases during pregnancy, it usually starts again postpartum. 34 Thus, it is important to ask about abuse before, during, and after pregnancy.
Adolescent dating violence Adolescents may suffer from an array of abusive behaviors, ranging from verbal and emotional abuse, to physical abuse, rape, and even homicide. Some teens are battered by people with whom they are dating, while others may be abused by parents or other caregivers. Teens in dating relationships often confuse jealousy with love. They may willingly give up passcodes and private electronic information under the pressure of an abusive partner. Lack of experience and perspective regarding healthy relationships can also affect the power dynamics in the relationship, especially if the teen’s partner is significantly older. All of these factors make teens more vulnerable to being controlled. Striving for independence, battered relationship. Doctors should screen adolescents for abuse as described below, remembering that the abuser may be a parent, another family member, boyfriend, or girlfriend. The teen’s knowledge and behavior around violence, coercion, alcohol, drugs, and sexual activity needs to be assessed. An abused teen particularly needs to be told that the abuse is not their fault and that help is available (see the list of resources at the end of this document). Violence in lesbian, gay, bisexual, transgender, and other gender and sexual minority (GSM) relationships teens may be especially reluctant to seek help from authority figures such as health care providers. Clinicians should reassure teens about the confidential and supportive nature of the doctor-patient
IPV in GSM relationships appears to be as common, or possibly more common, than in heterosexual relationships. 37-39 Many GSM individuals do not feel comfortable disclosing their sexual orientation to healthcare providers, and are likely to be even more reluctant to disclose abuse. GSM individuals who do disclose their sexual orientation are still rarely asked about IPV. Barriers to inquiry include gender-related myths, for example, that men cannot be victims of abuse, or that same-sex relationships are inherently “equal” because parties are of the same gender. 37,40 Additional obstacles specific to GSM survivors include homophobia and transphobia and resulting discrimination in society and among healthcare providers as well as social consequences of revealing one’s sexual orientation, such as loss of children and other family relationships, employment, or community Violence in diverse cultures and immigrant populations IPV is prevalent in every culture and segment of society. Immigrants and members of minority cultures, however, face extra hurdles as they attempt to access available services to protect themselves, their children, and other dependents. Patients of different cultures may hold belief systems and traditions that make it harder for them to perceive their own danger, understand their right to live in safety, know their legal rights and options, or even speak to anyone about their situation. Survivors whose native language is not English may find it difficult to communicate Substance abuse Substance abuse is often associated with violence. Perpetrators are more likely to use or abuse alcohol and other substances, and, in addition, patients who abuse alcohol and other drugs are more likely to become victims. Further, survivors of partner violence are more likely to abuse alcohol and to receive multiple prescriptions for tranquilizers, sedatives, and opioid analgesics to treat the pain or
standing. Shelter space and support services may not be available specifically for battered gay men, transgender, and gender nonconforming individuals. Lesbian and bisexual women have the option of going to more traditional domestic violence programs that accept women, but many of these programs may not be suitable for or sensitive to members of the GSM community. Transgender and gender-nonconforming individuals face particular barriers in getting help because providers, and the public in general, often understand even less about gender identity and expression than they do about sexual orientation. Healthcare providers should therefore approach screening, diagnosis, and treatment with special sensitivity to the difficult issues that abused GSM patients may face. with healthcare providers, advocacy services, and law enforcement personnel. They may also harbor legitimate fears of becoming homeless, losing their children, or deportation, if their abuse is revealed. These patients may not trust the health care system, and thus suffer in silence and be at risk. Healthcare providers who are sensitive to the potential barriers and problems that immigrants and members of diverse cultures face can better establish trusting relationships with their patients, which is critical for uncovering and dealing with IPV. distress of present or past abuse. 9 With rising rates of opioid abuse, physicians should consider increasing screening of violence in their patient population. Although most abused individuals are neither dependent on alcohol nor involved with other drugs, those who are addicted are often doubly stigmatized. They may be labeled as sexually promiscuous, unfit as
Book Code: CT24CME
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